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Full text of "United States Navy Medical News Letter Vol. 45 No. 1, 15 January 1965"

NAVMED P-5088 




CONTENTS 
IMPORTANT — Medical News Letter Renewal Notice Required 



21 



MEDICAL ABSTRACTS 

Complications of Neurologic Diagnostic Procedures 
Heat Illness and Related Problems 



FROM THE NOTE BOOK 

Cobalt 60 Unit — Portsmouth, Va. 

SecNav Honors 2 Navy Doctors 

Correspondence Course in Hematology Now 

Available 

American Board Certifications 

Navy Doctor Gets Army Medal 

PanAm Assn of Ophthalmology 

Medical Support for Steel Pike I 



OCCUPATIONAL MEDICINE 

Large Accident Toll Among Men at the Working 

Ages 

Contact Dermatitis Caused by Saran Wrap 

Chromium in Welding Fumes 

Patch Testing 

Mixtures of Household Cleaners 

Prevention of Heat Illness in Industrial Environment 
X-33 Water Repellent 

RESERVE SECTION 

Medical School Graduates Taste Navy Life on 
River Trip 

Seminar on Leprosy 

Reserve Dental Officers Seminar 



10 
12 
12 
13 

14 

14 
15 



15 
16 
16 



DENTAL SECTION 

Pulpal Reactions to Active and Arrested Dentinal 

Caries 7 

Drugs Used for Gingival Retraction 7 

Trends in Dental Materials 8 

The Language of Radiology 8 

Personnel and Professional Notes 9 



MISCELLANY 

General Hospitals and Psychiatric Patient Care 

American Board of Ob-Gyn 

Oak Knoll Resident Wins Award 

The 12th General Conference on Weights and 

Measures 

8 New and Revised Correspondence Courses 

Space and Astronautics Orientation Course 



17 
17 
18 

18 
19 
20 



United States Navy 
MEDICAL NEWS LETTER 



Vol. 45 



Friday, 15 January 1965 



No. I 



Rear Admiral Edward C. Kenney MC USN 
Surgeon General 

Rear Admiral R. B. Brown MC USN 
Deputy Surgeon General 

Captain M. W. Arnold MC USN (Ret), Editor 
William A. Kline, Managing Editor 

Contributing Editors 

Aviation Medicine Captain C. E. Wilbur MC USN 

Dental Section Captain C. A. Ostrom DC USN 

Occupational Medicine CDR N. E. Rosenwinkel MC USN 

Preventive Medicine Captain J. W. Millar MC USN 

Radiation Medicine CDR J. H. Schulte MC USN 

Reserve Section Captain C. Cummings MC USNR 

Submarine Medicine CDR J. H. Schulte MC USN 



Policy 

The U.S. Navy Medical News Letter is basically an 
official Medical Department publication inviting the 
attention of officers of the Medical Department of the 
Regular Navy and Naval Reserve to timely up-to-date 
items of official and professional interest relative to 
medicine, dentistry, and allied sciences. The amount 
of information used is only that necessary to inform 
adequately officers of the Medical Department of the 
existence and source of such information. The items 
used are neither intended to be. nor are they, sus- 



ceptible to use by any officer as a substitute for any 
item or article in its original form. All readers of the 
News Letter are urged to obtain the original of those 
items of particular interest to the individual. 

Change of Address 

Please forward changes of address for the News Letter 
to: Commanding Officer, U.S. Naval Medical School, 
National Naval Medical Center, Bethesda, Maryland 
20014, giving full name, rank, corps, and old and new 
addresses. 



FRONT COVER: U. S. NAVAL HOSPITAL, PHILADELPHIA, PA. The U.S. Naval Hospital is situated in 
South Philadelphia, within one mile of the Naval Base. It is a 1200 bed general hospital, with a large outpatient 
clinic in addition to a large inpatient census. The hospital serves as the principal medical support activity for 
the Philadelphia Naval Base, the Naval Home (for retired personnel); the Naval Air Station, Willow Grove, the 
Naval Air Development Center, Johnsville, and the Naval Supply Depot, Mechanicsburg, Pa. 

In addition to providing all other types of specialty care, special treatment facilities are available for Surgery 
for the Deaf, for Aural Rehabilitation (see the Medical News Letter 44(10): November 27, 1964), for Ampu- 
tations, and also for Psychiatric and Neurological patients. Editor 



The issuance of this publication approved by the Secretary of the Navy on 4 May 1964. 



U.S. NAVY MEDICAL NEWS LETTER 



Complications of Neurologic Diagnostic Procedures 

LCDR Lyndon U. Anthony MC USNR*. From the Proceedings of the Monthly Staff 
Conferences of the U. S. Naval Hospital, NNMC, Bethesda, Md., 1963-1964. 



In the past several years interest in, and application 
of, newer diagnostic procedures used in neurologic prob- 
lems have increased strikingly. For this reason it is 
considered important for all physicians to have a knowl- 
edge of these procedures, and it is the purpose of this 
discussion to deal specifically with complications of 
these procedures. Every complication mentioned has 
been seen by the lecturer, unless otherwise noted. 

It is difficult to arrive at a true indication of the inci- 
dence of complications, because there is no set plan for 
reporting such complications. Furthermore, incidence 
rates vary considerably depending upon the experience 
of the operator and his indications for the procedure. 
However, the important point to remember is that com- 
plications of each of these procedures occur with 
enough frequency to render it necessary that we give 
them due consideration before undertaking them. 

ANGIOGRAPHY 

A. Carotid 

Carotid angiography was initially performed by the 
open technic, that is, an operative cutdown was per- 
formed on the carotid in the neck. Of course, as with 
any surgical operation, there is danger of anesthetic 
reaction and infection. In addition, there are the risks 
listed below under the percutaneous technic. 

The majority of carotid angiograms are now done 
under local anesthesia with a percutaneous technic. 
Infection with this technic is extremely rare. There is 
only one report of cervical abscess in the literature, 
and our department has seen none. True allergic or 
anaphylactic reactions are also rare. I have seen only 
one in which there were asthma, urticaria, and hypo- 
tension. The most common adverse complication is 
the development of cervical hematoma during or just 
after the procedure. Occasionally this will be severe 
enough to cause tracheal compression and necessitate 
tracheostomy. Temporary paralysis of a vocal cord 
by the local anesthetic occurs frequently and when 
coupled with a cervical hematoma, or when the paraly- 

* Staff physician of the Neurosurgery Service, USNH, NNMC, 
Bethesda, Md. 



sis is bilateral (as it could be with bilateral angiography), 
tracheostomy is often necessary. 

The most common cause of complication with per- 
cutaneous carotid angiography is trauma to the vessel 
wall itself. This includes complete extravasation of the 
dye, as well as subintimal injection resulting in partial 
occlusion. Likewise, there is the theoretical possibility 
of spasm as a result of the needling. The most common 
effect of any of these types of trauma is a partial oc- 
clusion of the vessel, which commonly leads to transi- 
ent hemiparesis (and aphasia if the dominant hemisphere 
is involved). Fortunately, this type of hemiparesis 
ordinarily clears within 2 to 48 hours; however, an oc- 
casional one will be permanent. Another type of 
needle trauma is the development of carotid-jugular 
fistula. Fortunately these are surprisingly uncommon, 
and I have seen only one which required surgical cor- 
rection. 

An extremely rare complication can occur in patients 
with intracerebral aneurysms. Although it has to my 
knowledge been only reported once in the literature, I 
have seen two aneurysms which ruptured at the time 
of carotid injection, with the expected devastating re- 
sults. 

In an occasional case of cerebral tumor or abscess, 
the patient will gradually deteriorate several hours after 
an apparently uneventful carotid angiogram. This is 
thought to be due to an increase in cerebral edema due 
to an effect of the contrast media on the blood-brain 
barrier. 

Although as stated above it is difficult to arrive at an 
accurate estimate of complication incidence, an idea of 
the problem may be gained from the following: in a 
year's period, during which about 350 carotid angio- 
grams were performed and in a program in which new 
residents were being trained to do the procedure, the 
occurrence of major complication was 6% and the 
mortality for the angiograms and its associated anesthe- 
sia was 1.5%. 

B. Vertebral 

Percutaneous vertebral angiography is technically 
more difficult to perform than carotid angiography. 



U.S. NAVY MEDICAL NEWS LETTER 



Even in the most experienced hands it is only about 
75% successful. Because of this and the potential 
dangers, many centers are now using some form of 
brachial, subclavian, or femoral approach for visualiza- 
tion of the vertebral-basilar system. 

The complications of vertebral angiography are pre- 
dominantly those of partial occlusion or even complete 
thrombosis due to the trauma of attempted punctures. 
When either of these occurs, the results are apt to be 
profound due to paralysis of respiratory and cardiac 
centers. Similar results are obtained by single injections 
of large amounts (usually more than 15 cc.) of con- 
trast material. 

Except for specific problems (such as posterior A-V 
malformations) it is considered wiser to use one of the 
approaches discussed below for visualization of the 
vascular system in the posterior fossa. 

C. Brachial 

Catheterization of the brachial artery, in the arm or 
at the elbow, is a satisfactory method of visualizing the 
posterior cranial circulation. This technic involves 
either passing a catheter into the brachial and up into 
the subclavian or insertion of a large needle into the 
brachial and injecting with a pressure injector. Origi- 
nally, the brachial artery was exposed by cutdown, and 
so the risk of wound infection was present. Now most 
brachial angiograms are done percutaneously, and the 
complications are those of trauma to the brachial artery, 
with only a rare allergic or anaphylactic reaction to the 
contrast material. It is quite common that the radial 
pulse is lost for 2-3 days after brachial puncture. In 
two instances I have seen severe ischemia of the fore- 
arm and hand, and one of these necessitated the ampu- 
tation of the arm. 

When a catheter is threaded into the brachial, when 
ft is passed centrally, it frequently enters the vertebral 
orifice and passes up the vertebral artery. If this is 
not recognized, a large amount of dye may be injected 
and may result in brain stem injury. 

D. Subclavian 

Within the past six years, direct percutaneous injec- 
tion of the subclavian artery for posterior fossa angi- 
ography has come into vogue. At first, this was per- 
formed through a supraclavicular route, but the high 
incidence of hemomediastinum, hemothorax, and 
pneumothorax has decreased the original fervor for this 
approach. (I have even seen a dissecting aneurysm of 
the innominate and right subclavian system following a 
subintimal injection of the right subclavian artery.) 
More recently an infraclavicular approach to the sub- 
clavian has been used with a much decreased incidence 
of these complications. However, they still occur oc- 
casionally, the most common being pneumothorax. 



E. Femoral 

Here again, femoral catheterization has been found 
to be useful for study of the posterior fossa circulation 
as well as the carotid system. The complications from 
this route have been in general due to the associated 
trauma to the femoral vessels themselves, with result- 
ant ischemia of the lower extremities. 

F. Sinography 

Injection of the superior sagittal sinus through a burr 
hole or through the anterior fontanelle in an infant, has 
little clinical use. The only complication I have seen 
from this procedure has been one instance of thrombo- 
sis of the superior sagittal sinus. Ordinarily the in- 
formation gained from this test can be gained by the 
usual carotid angiogram. 

LUMBAR PUNCTURE 

By far the most commonly performed neurologic 
diagnostic procedure is, of course, lumbar puncture. 
Although the incidence of complication is slight, there 
are specific conditions in which the incidence rises 
markedly and the complication may be devastating to 
the patient. 

Infection following lumbar puncture is most uncom- 
mon, and 1 have seen only one. That was an epidural 
abscess which is a surgical emergency. 

In the presence of a cerebral mass lesion, cerebral 
edema, or obstruction to the normal flow of cerebro- 
spinal fluid, lumbar puncture may lead to a marked 
worsening of the patient's condition. This may come 
on immediately, or up to 24 hours after the lumbar 
puncture. The deterioration is usually associated with 
either uncal or tansillar herniation. Uncal herniation 
is more common with temporal lobe masses and other 
supratentoriai lesions; tonsillar herniation is more com- 
mon with posterior fossa lesions; both tonsillar and 
uncal herniation may result in the development of mid- 
brain hemorrhage; the grave danger of acute tonsillar 
herniation is medullary compression. In general, the 
more acute the clinical history, the greater the risk of 
the lumbar puncture, but the complications do occur 
in what are apparently chronic processes. 

The situations in which one should very cautiously 
consider the risks of LP are: (1) acute, i.e., less than 
a week, clinical history; (2) evidence of pressure on 
skull films; (3) papilledema; (4) slow pulse; (5) history 
suggestive of brain abscess or cerebellar mass; (6) the 
suspicion of intracranial mass or trauma in the elderly, 
because they often do not show papilledema although 
the pressure is high. There is no such thing as a 
"routine LP"; before doing any LP, one should be sure 
that there is a good chance of finding clinically USE- 
FUL information which will influence the CLINICAL 
diagnostic work-up or therapeutic course. For example, 



U.S. NAVY MEDICAL NEWS LETTER 



in the usual acute head injury there is little or no ad- 
vantage in knowing whether the CSF is bloody or the 
pressure is high — the treatment is unchanged by this 
information. If for a particular patient there is any 
question about the above points, the course of wisdom 
is NOT to do the LP, but request neurosurgical advice. 
THERE IS NO SUCH THING AS A LUMBAR 
PUNCTURE SO URGENT THAT IT MUST BE 
DONE BEFORE OBTAINING A BRIEF HISTORY, 
OBTAINING SKULL FILMS, EXAMINING THE 
OPTIC FUNDI, OR COUNTING THE PULSE. It 
may be argued by some, in a specific instance in which 
herniation has occurred after LP, that in the natural 
history of the basic lesion, herniation develops. Al- 
though this is true, a general and massive experience 
illustrates that herniation is hastened and made more 
profound by LP. We do not excuse murder on the basis 
that man is mortal. 

In cases of spinal block, particularly in spinal cord 
tumors, lumbar puncture may lead to a rapid deteriora- 
tion of the clinical course. This may result from a 
change of the CSF dynamics, from a change in vascular 
dynamics, or from actual movement of the tumor. 
The most common problem resulting from lumbar punc- 
ture in the case of spinal block is that the subarachnoid 
space below the block may be collapsed and not refill. 
This means that an LP for myelography later may be 
impossible, and one must then resort to cisternal 
puncture. Lumbar puncture should not be done in 
cases of strongly suspected spinal cord tumor except 
at the time of myelography ^and when one is prepared 
to go directly to surgery if a complete block is found. 

CISTERNAL PUNCTURE 

All the possible complications of lumbar puncture 
apply equally to cisternal puncture. In addition, there 
is the danger of the needle passing into the medulla, 
and in cases of tonsillar herniation, there is the danger 
not only of inserting the needle into the tonsil, but also 
of causing damage to the inferiorly displaced posterior 
inferior cerebellar artery. Fortunately, I have seen 
none of these complications, because cisternal puncture 
is rarely needed. 

MYELOGRAPHY 

The risks of myelography are essentially the same as 
those discussed under lumbar puncture. Where there 
is spinal block, one must be prepared to go directly 
ahead with surgery. 

PNEUMOENCEPHALOGRAPHY 

Pneumoencephalography, of course, portends all the 
risks of LP, and in conditions of increased intracranial 
pressure, there is a marked risk of herniation. In the 



neurological literature, there are many reports of the 
safety of the PEG with increased pressure, and it is 
true that in the majority of the time this is safe. How- 
ever, complications do occur, and are catastrophic 
when they do. I have seen this happen on five -occa- 
sions; fortunately, in each of these, burr holes were 
present and the condition was relieved immediately by 
ventricular puncture. 

Pneumoencephalography (or any intracranial air 
study) has an additional risk in degenerative diseases 
of the CNS even in the absence of increased pressure. 
Particularly in cerebral degenerative processes, it is 
often seen that the patient's clinical condition will de- 
teriorate markedly after air study. The cause of this 
is not known. 

VENTRICULOGRAPHY 

Of all the specialized neurologic diagnostic proce- 
dures, including lumbar puncture, ventriculography is 
by far the safest. When burr holes are necessary, as 
is'usually the case with adults, there is the usual risk 
of infection. Subdural hematomas as a result of the 
burr holes are reported, and I have seen one. The 
most serious risk is that of passing the ventricular 
needle into a highly vascular tumor, such as a menin- 
gioma. Occasionally the resultant bleeding is so severe 
that even immediate surgery is not successful. The 
most common complication of ventriculography is a 
transient homonymous hemianopia due to passage of 
the needle through the occipital cortex. Ordinarily 
this clears spontaneously within 5-6 days. In the pres- 
ence of a tumor or CSF block, it is wise to follow the 
ventriculogram with surgery, because cerebral swelling 
often increases after the irritation of air. 

Transcoronal ventriculography, as can be performed 
in infants, also carries theoretically the risks noted 
above, but I have seen no complication of this pro- 
cedure. 

SUMMARY 

Although there is a significant incidence of compli- 
cations with almost every one of the above procedures, 
there are still benefits to be obtained from them which 
often far outweigh the risks. But it is essential to be 
aware of the risks and to be prepared to cope with them. 
The most important thing to be learned from this 
discussion is that lumbar puncture is not always an in- 
nocuous procedure, and it should never be considered 
"routine." It should be performed only after a history, 
at least visualization of the fundi and palpation of the 
pulse, and examination of skull films. It is impossible 
to justify LP otherwise. 



U.S. NAVY MEDICAL NEWS LETTER 



Heat Illness and Related Problems 



% 



A. W. El Halawani MD, Saudi Arabia, World Health Organization, WHO Chronicle, 
18(8): 288-298, August 1964 



SOME UNRESOLVED PROBLEMS 

The boundaries of environmental physiology are still 
hardly visible, so it is not difficult to make suggestions 
for further research. An international committee has 
listed about forty possible projects, many of which 
would fit appropriately into the International Biological 
Programme proposed by the International Council of 
Scientific Unions. The time has clearly come to con- 
sider man's adaptation to natural rather than artificial 
environments, and field studies would be both appro- 
priate and welcome. Immense opportunities appear to 
exist in the Mecca Pilgrimage for resolving some out- 
standing problems. For example, the pathogenesis of 
prickly heat and of anhidrotic heat exhaustion is still 
something of a vexed question; and, although possibly 
of profound importance, the pathogenesis of heat stroke 
remains obscure. 

One major question which has been asked repeatedly 
about heat stroke and is still unanswered is whether 
cessation of sweating precedes or follows hyperpyrexia. 
As one of the most urgent of medical emergencies, the 
immediate treatment of this disorder has priority over 
investigations. It is usually a catastrophe of sudden 
and unheralded onset, and its earliest stages are seen 
rarely or not recognized. A high mortality even with 
effective cooling rules out experimental induction of 
the disorder in man. These are at least some of the 
reasons why we have no clear picture of the patho- 
genesis of heat stroke. A second major point which 
remains unanswered is what degree or duration of 
hyperthermia causes irreversible damage to the cen- 
tral nervous system. But there are many questions 
and few answers in this enigmatic disorder; the ques- 
tions are stimulating, but to the physician the lack of 
answers is disheartening. Heat stroke is apparently 
unique. Hyperpyrexia is not uncommonly a terminal 
event in general medicine, but what are the essential 
differences between heat stroke and the moments of 
hyperpyrexia which occur occassionally in the major 
fevers? Does heat stroke represent a sudden adrenal 
insufficiency or failure in the face of severe and sus- 
tained thermal stress? It is interesting that, unless 

* Continued from Occupational Medicine Section of U.S Navy 
Medical News Letter, 44(10): 14-18, Nov. 27, 1964. This is the 
second installment. 



heralded by a sudden and clear-cut deterioration late 
in the course of heat stroke, the advent of adrenal 
insufficiency would be hard to recognize: hyperpyrexia, 
petechial and ecchymotic haemorrhages, cyanosis, and 
shock are features common to adrenal apoplexy and 
heat stroke. Of the problems that have been listed, 
there are clues only to one: the cessation of sweating. 

Absence of sweating is called anhidrosis. The 
term is used to imply a partial or complete failure 
either of the production of sweat or of its delivery to 
the skin surface. It has been found clinically con- 
venient to describe as anhidrotic an individual whose 
skin is dry when those around him can be seen to 
sweat profusely, or a patch of skin that is dry when 
the rest of the body surface is damp with sweat. Dry- 
ness of the skin in a hot and dry climate may mean 
that anhidrosis is present, or simply that sweat is 
being evaporated almost as fast as it is being delivered 
to the skin surface. In anhidrotic heat exhaustion 
there is interference with the delivery of sweat to the 
skin surface, but it has long been believed that in heat 
stroke there is mainly a failure to produce sweat. 

A decline in thermal sweating measured by changes 
in nude body weight has been observed frequently in 
experimental subjects after an hour or two in a high 
environmental temperature or during more prolonged 
exposure to humid heat. For want of a specific title, 
the phenomenon has been called fatigue of the sweating 
mechanism, and it is known to be independent of water 
depletion. It is possibly significant that in addition to 
the decline in sweating, the usual stimulation of eccrine 
sweating by locally injected acetylcholine (or analogues 
such as pilocarpine and carbachol) is impaired, for it 
is on record that the anhidrosis of heat stroke does not 
respond to pilocarpine; however, anhidrosis resulting 
from interference with the delivery of sweat also fails 
to respond to these drugs. According to one experi- 
enced worker, the so-called fatigue of sweating may be 
explained as follows: the amount of sweat produced per 
unit rise in body temperature declines exponentially as 
the body temperature rises, so that the total sweat pro- 
duction ceases to rise with increased body temperature 
at a rectal temperature of about 38.5° C (101.3° F), 
and thereafter further increases in body temperature 
result in less sweat being produced, until at about 



U.S. NAVY MEDICAL NEWS LETTER 



40.5° C (104.9° F), if the same process were to con- 
tinue, sweating would cease. This implies a physio- 
logical mechanism for the anhidrosis in at least some 
cases of heat stroke, but the occasional absence of 
sweating observed at rectal temperatures below 38.9° C 
(102° F), the recent report of sweating in an other- 
wise classical case of heat stroke, and the comparative 
rarity of heat stroke all suggest, however, that this re- 
lationship between anhidrosis and hyperpyrexia is by 
no means the only one, nor need it necessarily occur. 

There are two alternative lines of approach. It has 
long been considered that the anhidrosis of heat stroke 
might be due to a failure of innervation of the sweat 
glands due to dysfunction of the hypothalamic centre 
for heat dissipation or of the "neuroeffector" junction 
at the periphery. Post-mortem examination of fatal 
cases of heat stroke has so far shown nothing which 
might have initiated either anhidrosis or hyperpyrexia; 
the changes seen in the hypothalamus, as elsewhere, 
appear to be a result rather than the cause of the dis- 
order. Failure to demonstrate histological abnormali- 
ties in post-mortem sections does not, however, ex- 
clude the presence of a functional lesion in life. The 
second alternative is that in some cases the anhidrosis 
of heat stroke might be due, as in anhidrotic heat ex- 
haustion, to interference with the delivery of sweat to 
the skin surface. When the skin is 100% wetted with 
hypotonic sweat, water is reabsorbed and collects in 
its upper layers; and it has been suggested that part 
reabsorption of sweat in this way may lead to obstruc- 
tion of sweat ducts, and account for the onset of "fa- 
tigue" of sweating in humid heat. If this is true and at 
all relevant to the pathogenesis of heat stroke, it would 
seem to imply that anhidrosis may precede hyperpyrex- 
ia in humid climates. 

Worthy perhaps of more immediate attention than 
other existing theories about the anhidrosis of heat 
stroke is the recent report from Israel of sweating in 
the presence of hyperpyrexia and coma. Regardless of 
the semantic and more significant arguments that can 
and no doubt will be marshalled against this report, it 
must serve as a sharp reminder that the term "anhi- 
drosis" is often abused. The "hot dry skin" of heat 
stroke is in all the textbooks; how many physicians see 
and report what they have been told to see? How often 
is the significance of a hot dry skin questioned in a hot 
dry climate? The facts appear to be that not since 



1932 has there been a report on the effect of pilo- 
carpine on the anhidrosis of heat stroke; a starch and 
iodine or similar test for moisture on the skin has not 
been employed in this disorder; the measurement of 
evaporative fluid losses by changes in nude body weight 
has not been used either to establish the presence or 
absence of sweating in heat stroke at the time of crisis, 
or to determine the stage in recovery at which sweat- 
ing returns. These may seem astonishing admissions, 
but only to those who have never shared in the dra- 
matic urgency of treatment. 

Another large gap in our knowledge of human re- 
sponses to heat concerns the potassium balance. A 
rise in the plasma potassium level following oral intake 
of potassium chloride has been shown to be twice as 
great in Europeans and Indians in Madras as in Euro- 
peans in Europe; and the significance of this observa- 
tion is not yet clear. The ratio of sodium to potassium 
in the thermal sweat of unacclimatized individuals is 
at least 6:1, and in a state of normal fluid and electro- 
lyte balance sweat is always hypotonic to plasma in 
regard to these cations. Potassium losses in sweat 
would appear therefore to be of no importance; how- 
ever, as a result of adaptations to fluid and sodium 
losses in prolonged sweating, sodium may virtually dis- 
appear from both urine and sweat while the potassium 
level in both remains about the same and may in- 
crease. According to some authorities, the potassium 
concentration in the sweat in such circumstances may 
be higher than in the plasma. Daily potassium losses 
by this route in men working for eight hours daily in 
hot surroundings may therefore be significant, for ex- 
ample, and comparable to losses in chronic diarrhoea. 
It has been suggested, and reasonably so, that potassium 
depletion is entirely consistent with some of the fea- 
tures of the heat disorders, notably weakness and 
lethargy and Pitressin-resistant polyuria. The plasma 
potassium level in salt-depletion heat exhaustion is 
usually within normal limits, but the use of an isotope- 
dilution method to estimate total exchangeable potas- 
sium in this disorder might provide very interesting 
results. Similarly, the hypokalemia typical of heat 
stroke is probably related to acid-base disturbance re- 
sulting from hyperpnoea and respiratory alkalosis, but 
it would be valuable to have this assumption validated. 

(To be continued) 



FROM THE NOTE BOOK 



NEW COBALT 60 UNIT 
AT PORTSMOUTH, VIRGINIA 

A new Cobalt 60 Therapy Unit was dedicated at the 
U.S. Naval Hospital, Portsmouth, Virginia, on 18 



November 1964 by RADM Edward C. Kenney, Sur- 
geon General of the Navy. The new unit is a welcome 
addition to the modern radiology facilities at this hos- 
pital. This is the fifth cobalt unit to be installed in 
U.S. Naval Hospitals and will be available for treat- 



US. NAVY MEDICAL NEWS LETTER 



ment of personnel of all branches of the armed serv- 
ices and their dependents. 

The new unit was installed in Building 1 taking ad- 
vantage of the architectural plan for this, the oldest 
Naval Hospital building in the United States Navy. It 
requires considerably more shielding than the conven- 
tional X-ray equipment and found an ideal home in the 
granite walls of this building which was originally 
planned and built approximately thirty years before the 
Civil War. In studying the available sites for the Co- 
balt Unit, physicists found that the granite block walls 
provided ideal shielding and the additional changes re- 
quired were appropriate barriers to redivide the space 
and to fill in several windows. 

When a patient is under treatment the cobalt therapy 
room door is closed and the entire surrounding area is 
radiation safe. The doctor and a qualified technician 
manipulate the control panel from an adjacent room and 
watch the patient through a lead glass window and con- 
verse with him through a sensitive intercom system. 
—Submitted by CAPT John W. Albrittain, MC, USN, 
Acting Commanding Officer, USNH, Portsmouth, Va. 

SECNAV HONORS TWO NAVY DOCTORS 

The Secretary of the Navy, the Honorable Paul H. 
Nitze, has presented the Navy Commendation Medal to 
LCDR Gerald J. McClard, MC USN and to Lt Homer 
L. Dixon, MC USNR for service as set forth in the 
following CITATION: 

"For meritorious achievement on 26 June 1964 as 
crew members of an LC-130F aircraft during an emer- 
gency flight from Christchurch, New Zealand to 
McMurdo Station, Antarctica, resulting in the lifesav- 
ing evacuation of a critically injured shipmate. Your 
conduct throughout this unusually extended and ex- 
tremely hazardous flight to and from the Antarctic 
Continent was in keeping with the highest traditions 
of the naval service." 

CORRESPONDENCE COURSE IN 
HEMATOLOGY NOW AVAILABLE 

"The Medical Department Correspondence Course 
'Hematology,' NavPers 10501, is now ready for distri- 
bution to eligible regular and reserve officer and en- 
listed personnel of the Armed Forces. Applications for 
this course should be submitted on Form NavPers 992 
(with appropriate change in the To' line), and for- 
warded via appropriate official channels to the Com- 
manding Officer, U.S. Naval Medical School, National 
Naval Medical Center, Bethesda, Maryland 20014. 

"The purpose of this course is to provide a concise 
guide to hematologic procedures. Included are ele- 
ments, origins, and functions of blood and methods for 
conducting diverse hematologic tests. Allied courses 
in Clinical Laboratory Procedures are under develop- 
ment and will be available in the near future. 

"The course is composed of two (2) objective-type 



assignments and is evaluated at four (4) Naval Reserve 
promotion and/or non-disability retirement points. 
These points are creditable only to personnel eligible 
to receive them under current directives governing 
retirement and/or promotion of Naval Reserve person- 
nel. Individuals who have previously completed course 
'Clinical Laboratory Procedures.' NavPers 10994, will 
receive additional credit for completing this course." 
—From CAPT R. F. Dobbins, Acting CO, U.S. Naval 
Medical School, NNMC, Bethesda, Md. 

AMERICAN BOARD CERTIFICATIONS 

American Board of Anesthesiology 

LT Louis B. Swisher Jr MC USN 
American Board of Dermatology 

LCDR Jerome Levy MC USN 
American Board of Pathology 

CDR Calvin F. Bishop MC USN 

LCDR Martin J. Valaske MC USN 

LT Robert C. Block MC USN 
American Board of Preventive Medicine (Aviation 
Medicine) 

CDR Channing L. Ewing MC USN 
American Board of Surgery 

LCDR Thomas R. Mainzer MC USN 

NAVY DOCTOR GETS ARMY MEDAL 

USS TICONDEROGA (CVA-14) AT SEA, Nov. 15 
—LCDR Walter D. Gable, Medical Corps, U.S. Navy, 
was awarded the Army Commendation Medal aboard 
this attack aircraft carrier while the ship was moored 
at Hong Kong, BCC, Nov. 13. 

CAPT Damon W. Cooper, commanding officer of 
Ticonderoga, presented LCDR Gable with the medal in 
ceremonies in Ticonderoga' s hangar bay. 

LCDR Gable was awarded the medal through 
Stephen Aile, Secretary of the Army, for meritorious 
service while serving as a pathologist and flight sur- 
geon with the Aerospace Branch, Military Environ- 
mental Pathology Division, Armed Forces Institute of 
Pathology, Washington, D.C., from Oct, 1961 to May 
1964. 

A commendation letter accompanying the medal 
states, in part: ". . . Commander Gable's informative 
and comprehensive studies on the cause of death in 
aeroplane accidents contributed in a great measure to 
the field of aviation safety, 

". . . he rendered exceptional service to the advance- 
ment of aviation pathology by devoting his time and 
efforts in the training and education of both American 
and foreign medical officers in aviation pathology. 

"Commander Gable's outstanding performance of 
duty throughout this period reflects the utmost credit 
upon himself, the United States Navy, and the military 
service." 

A unit of the powerful U. S. Seventh Fleet, Ticon- 
deroga is homeported in San Diego, Calif. 
— Tico News Release No. 2-1164, November 15, 1964. 



U.S. NAVY MEDICAL NEWS LETTER 



PAN AMERICAN ASSOCIATION OF 
OPHTHALMOLOGY TO MEET 
IN RIO DE JANEIRO IN 1965 

The Pan American Association of Ophthalmology 
will hold an interim Congress in Rio de Janeiro, Brazil, 
from August 15 to August 21, 1965. Headquarters for 
this important meeting will be the famous Copacabana 
Palace Hotel on the Copacabana Beach. 

An interesting professional program of panel discus- 
sions and free papers is being arranged by Professor 
Werther Duque Estrada, University of the State of 
Guanabara, Rio de Janeiro, Brazil. As usual the social 
events will be outstanding. Special round-trip jet air 
fares have been arranged through Doctor Louis Girard, 
The Department of Ophthalmology, Baylor University, 
Houston, Texas. 

—From J. H. King, Jr., MD FACS, Chairman, Public 
Relations Committee, PAAO, 110 Irving St., N. W„ 
Washington D. C. 20010. 

MEDICAL SUPPORT FOR STEEL PIKE I 
RECEIVES HIGH PRAISE FROM 
ADM MCCAIN, GEN BERKELEY 

AND ADM KENNEY 

The Surgeon General wishes to take this opportunity 



DENTAL 



PULPAL RELATIONS TO ACTIVE AND 
ARRESTED DENTINAL CARIES 

M. Mossier and R. Kuwabara, Univ of III., Jour Dental 
Res 43(5) Part II: 807-808, Sept-Oct 1964. 

Pulpal reactions to caries were correlated clinically 
and histologically in three replicate series totaling 175 
human teeth. Caries progress is intermittent. Periods 
of activity could be distinguished clinically by pain 
reactions, a necrotic bacteria-laden surface layer, and 
a painful, softened, relatively bacteria-free subsurface 
layer. Arrested lesions showed a nonpainful, heavily 
pigmented, hard, leathery or sclerosed surface. His- 
tologically, the active lesions showed a wide decalcified 
layer of dentin which was highly permeable to dyes and 
isotopes, while the arrested lesions showed a wide zone 
of pigmented, sclerotic, and impermeable dentin. Sclero- 
sis of dentin and reparative dentin formation began 
early, toward the end of the active period, and continued 
more slowly during the early period of arrest. Arrest 
lines were prominent in the reparative dentin, as were 
marked differences in structure within successive layers 




to commend those activities that recently provided med- 
ical support for operation "Steel Pike I". Operation 
Steel Pike was a large scale naval-marine and amphibi- 
ous exercise recently conducted in Spain. The coopera- 
tion and dedication to duty of those surgical teams, 
casualty evacuation teams and augmentees who sup- 
ported this operation have resulted in sincere recognition 
that the Medical Department is meeting our primary 
obligation, namely that of supporting the operating 
forces. 

The following excerpt from a message from CTF 
One-Eight-Four and CTF One-Eight-Seven testifies to 
the high quality of your services. "As our Westward 
Transit brings an end to this eminently successful exer- 
cise we cannot emphasize enough the splendid contribu- 
tion the surgical teams, casualty evacuation team, and 
wing augmentation surgeons made to this success. Your 
efforts were essential to provide the medical support re- 
quired. You responded to each medical emergency with 
professional skill and confidence. Your accomplish- 
ments have earned the respect and confidence of all 
hands. Our personal thanks for a job well done. S/Vice 
Admiral John S. McCain, Jr. USN, LTGEN J. P. 
Berkeley, USMC." 



SECTION 



of the reparative dentin. The layers and arrest lines 
probably reflect periods of caries activity and arrest. 
Effects on odontoblasts and subodontoblastic cells were 
relatively mild until the necrotic layer came within 30 
microns of the pulp. Pulpal inflammations were con- 
spicuously absent under superficial and shallow lesions 
in spite of clinical symptoms, relatively mild under 
moderately deep lesions and prominent only under very 
deep active lesions. When compared to the effects of 
various cutting procedures, filling materials, and medica- 
ments, the pulpal reactions to the caries attack were 
much more productive of dentinal sclerosis in advance 
of the lesion and in reparative dentin formation in the 
pulp. 
AN EVALUATION OF THE DRUGS USED 
FOR GINGIVAL RETRACTION * 

Felix F. Woycheshin DDS, Univ of Texas Dental 
Branch, Houston, Texas, Jour Pros Den 14(4): 769-776, 
July-Aug 1964. 

The elastic impression materials such as the hydro- 
colloids and the rubber base impression materials, used 

•"This articie is copyrighted by the American Dental Association, 
Reprinted by permission. 



U.S. NAVY MEDICAL NEWS LETTER 



in the construction of inlays, crowns, and bridges, do not 
displace the gingival tissues and necessitate gingival re- 
traction to expose the gingival margins of the cavity 
preparations. Various methods of gingival retraction 
have been described in the literature. The most con- 
servative and widely used method consists of placing a 
cotton cord or cotton fibers which have been impreg- 
nated with a drug into the gingival crevice; another 
method is that of placing a cord and then applying the 
drug. These cords and drugs are left in the gingival 
crevice for varying lengths of time, depending upon the 
drug used and the condition of the gingival tissues. 

Various drugs have been used for gingival retraction, 
but no comparative study of the efficiency or undesira- 
ble characteristics of the drugs has been reported in the 
literature. This is a report of such a study, using dogs 
as the experimental subjects. The study was done in 
two parts. The first part was concerned with the relative 
ability of the drugs to retract the gingival tissues and 
local tissue injury, and the second part was concerned 
with systemic reactions. 

Summary 

1. Most of the drugs commonly used for gingival 
retraction are effective in shrinking the gingival tissues. 

2. Zinc chloride is caustic and prolonged application 
or high concentrations will cauterize the tissue. 

3. Negatan is highly acid and decalcifies the teeth. 

4. When very high concentrations or large amounts 
of epinephrine are applied locally to lacerated tissue, 
epinephrine can be absorbed and cause an increase in 
the heart rate and blood pressure, which could be dan- 
gerous for patients with cardiovascular disease, hyper- 
thyroidism, and to certain hypersensitive individuals. 

5. The application of high concentrations of epineph- 
rine to large areas of lacerated or abraded gingival 
tissues should be avoided. 

TRENDS IN DENTAL MATERIALS * 

Phillips, Ralph W ., Indiana Univ School of Den, Indian- 
apolis, Indiana, Jour Am Den Hyg Assoc, 38: 127-131, 
July 1964. Dental Abstracts 9(10): 631, October 1964. 

No dental restorative material adheres to tooth struc- 
ture, but the search for a metal or plastic that will bond 
chemically to the tooth continues unabated. Until such 
an adhesive cement or restorative is developed, concern 
must be given to technics that tend to minimize the 
leakage associated with existing materials. 

Probably the reason amalgam has served so effectively 
as a restorative material through 200 years is not any 
unique germicidal or antibacterial characteristic of this 
material but rather because of the tendency of amalgam, 
as it ages in the mouth, to inhibit leakage of deleterious 
agents. Amalgam that is six months old resists leakage 
better than amalgam two days old. The reduced leak- 
age probably is due to an accumulation of various sub- 
stances, corrosion products that mechanically fill the 
space between the restoration and the tooth, or little 



crystals of tin that may grow from the surface of the 
amalgam into the space. 

The desirable pulpal effects of zinc oxide-eugenol, 
although generally associated with its neutral pH, also 
may be associated with its tendency to adapt itself 
uniquely well to the cavity walls. The reduced leakage 
associated with this cement aids in minimizing further 
pulpal reactions. 

A cavity varnish, painted onto the prepared cavity 
before insertion of the restoration, aids in reducing the 
initial leakage around the amalgam or silicate restora- 
tion. Likewise, the varnish minimizes the possible pen- 
etration of acid into dentin from a zinc phosphate or a 
silicate cement. Such protection is essential in the deep 
cavity where the thin layer of remaining dentin may not 
be adequate to protect against permeability of acid. 

The unique anticariogenic behavior of the silicate 
restoration is now established. Although this restora- 
tion is soluble and leaks grossly, recurrent caries is 
seldom seen around it because of the high fluoride con- 
tent in the silicate powder. When the silicate restora- 
tion is inserted, the fluoride in the cement reacts with 
the adjoining enamel and dentin in a manner similar to 
that of topical application of fluoride to the enamel 
surface. Some of the newer resin materials incorporate 
2 per cent sodium fluoride in the polymer for the same 
reason. 

The importance of polishing the amalgam restoration 
has received further documentation. The polished 
amalgam surface is more resistant to tarnish and corro- 
sion than the carved surface. It is desirable to wait a 
week before polishing the surface of an amalgam resto- 
ration, and the surface should be repolished at each 
prophylaxis. Polishing must be done with care to avoid 
generating any heat; dry powders should not be used. 

THE LANGUAGE OF RADIOLOGY * 

Etter, Lewis E., School of Medicine, Univ of Pittsburgh, 
Pittsburgh, Pa., Am Jour Roentg 90: 656-658, Sept 
1964. Dental Abstracts 9(10): 657- 658, Oct 1964. 

Since 1912 the Committee on Nomenclature of the 
American Roentgen Ray Society has concerned itself 
with the terminology used in conjunction with the appli- 
cation of roentgen rays. Of the terms recommended by 
the committee, the following are in most common 
usage : 

roentgen: to be pronounced rentgen 

roentgen ray: a ray discovered and described by 

Wilhelm Konrad Roentgen 
roentgenology: a study and practice of the roent- 
gen rays as applied to medical 
science 
roentgenologist: one skilled in roentgenology 
roentgenogram: the shadow picture produced by 
the roentgen ray on a sensitized 
plate or film 
roentgenograph (ver) : to make a roentgenogram 

* These articles are copyrighted by the American Dental Association. 
Reprinted by permission. 



8 



U.S. NAVY MEDICAL NEWS LETTER 



With the increasing use of radium and later of various 
radioactive isotopes, both for diagnosis and treatment, 
the prefix of radio- was substituted for the prefix of 
roentgeno- in the foregoing nomenclature, to make a 
clear distinction between the two types of energizing 
sources. Thus a roentgenogram represents the shadow 
picture produced by the roentgen ray on a sensitized 
film, and a radiogram represents the shadow picture pro- 
duced by a radioactive source (cobalt 60, cesium 137, 
ytterbium 169, and so forth) on a sensitized film. In a 
similar sense the term autoradiograph is reserved for use 
in connection with radioactive isotopes. 

The term radiology is most comprehensive, including 
diagnostic radiology (roentgen ray diagnosis and diag- 
nostic radioisotopes), and therapeutic radiology (the 
application of all types of ionizing radiations in 
therapy). 



Laminagrams are prepared by laminagraphy, plani- 
grams by planigraphy, stratigrams by stratigraphy and 
tomograms by tomography. 

The radiologist should not fall into the jargon used by 
lay associates, such as, "What do the patient's x rays 
show?" "Take another set of x rays," or "Make some 
more films," 

The correct terms are: "The films reveal" or "The 
films show," "Expose films to roentgen rays" and "Get 
additional exposures." 

When all exposures have been made and the films are 
to be prepared for interpretation, are they developed or 
processed? Of course, more is entailed in "processing" 
than simply "developing," which is only the initial stage 
requiring a further water rinse before "fixing" and 
"clearing." 



PERSONNEL AND PROFESSIONAL NOTES 



Dental Training Committee. The Dental Training Com- 
mittee will meet in the Bureau of Medicine & Surgery 
in late February 1965 to consider applications from 
qualified dental officers for advanced training. Re- 
quests will be evaluated for assignment to the Graduate 
and Postgraduate Courses at 'the U. S. Naval Dental 
School, Graduate level courses in civilian institutions, 
American Dental Association approved residencies at 
Naval Facilities, and to the Postdoctoral Fellowship 
Training Program. In the Graduate and Postgraduate 
Courses at the U. S. Naval Dental School, it is planned 
that officers shall be assigned in the following numbers: 
General Dentistry — 14; Oral Surgery — 4; Prosthodon- 
tics — 4, Periodontics — 4; Oral Medicine — 1; and Endo- 
dontics — 1. At other Naval facilities and civilian insti- 
tutions, it is estimated that officers will be assigned as 
follows for specialty training: Oral Surgery — 8; Prostho- 
dontics — 6; Periodontics — 8; Endodontics — 2; and Pub- 
lic Health/ Preventive Dentistry — 1. It is not possible 
at this time to predict the numbers who will be assigned 
to Postdoctoral Fellowship Training (BuMed News Let- 
ter, 44(3): 25, 1964). 

Dental School Hosts Foreign Dentists. CAPT A. R. 
Frechette DC USN, Commanding Officer, U. S. Naval 
Dental School, NNMC, Bethesda, Maryland, hosted 
distinguished dental officers of the British Armed Forces 
and the Argentine Navy on 18 November 1964. 

Those visiting the Dental School were: Vice Air Mar- 
shall H. Keggin, CBE, QHDS, LDS, RAF, Director of 
Dental Services of the British Royal Air Force; Briga- 
dier General D. V. Taylor, CBE, Consulting Dental 
Surgeon to the British Army; Surgeon Captain (D) A. 
MacDonald- Watson, OBE, RN, Senior Consultant in 
Dental Surgery, British Royal Navy, and Captain Guido 
Mercurio, Dentist in the Argentine Navy. 

Naval Dental Officers Lecture on Dental Office Emer- 
gencies. CAPT S. E. Tande, DC USN, Head, Audio- 
visual Department, U. S. Naval Dental School, National 



Naval Medical Center, Bethesda, Maryland, and LCDR 
J. S. Lindsay, DC USN, Resident in the Oral Surgery 
Department, lectured at the Fall meeting of the Old 
Dominion Study Club of Virginia, held in October. 
CAPT Tande presented the preventive phase of Emer- 
gencies in the Dental Office and LCDR Lindsay pre- 
sented the treatment phase. Later in the program, the 
Study Club members participated in a demonstration of 
mouth-to-mouth resuscitation and closed cardiac mes- 
sage, utilizing the training manikin, "Resusci-Anne." 

Captain Ludwick Presents Essay Before Reserve Dental 
Companies. CAPT William E. Ludwick, DC USN, 
U. S. Naval Training Center, Great Lakes, Illinois, pre- 
sented an essay entitled Prevention of Dental Caries 
before the U. S. Naval Reserve Dental Companies 9-3 
and 9-5 on 20 November 1964 at the Naval Armory, 
Chicago, Illinois. 

Captain Cunther Presents Lecture in Japan. CAPT 
Lewis L. Gunther, DC USN, U. S. Naval Dental Clinic, 
Yokosuka, Japan, presented a lecture entitled Perio- 
dontics for the General Practitioner before the fall 
meeting of the American Stomatological Society of 
Japan on 9 November 1964 at the U. S. Naval Air 
Station, Atsugi, Japan. 

Captain Losee Participates in Science Symposium. 
CAPT Fred L, Losee, DC USN, U. S. Naval Training 
Center, Great Lakes, Illinois, participated in one of the 
two symposiums sponsored by the American Associa- 
tion for the Advancement of Science during the annual 
meeting held in Montreal, Canada 26-31 December 
1964. 

The symposium on Environmental Variables in Oral 
Disease was held 26-27 December in which CAPT 
Losee presented a review of studies indicating that 
trace amounts of elements other than fluorine in food 
and soil water appear to have a marked effect on caries 
incidence. 



U.S. NAVY MEDICAL NEWS LETTER 



List of Newly Standardized Items Available for Issue 



FSN 

6505-074-3171 
6510-074-1020 
6515-985-7106 
6520-076-8682 
6520-720-9499 
6520-721-6057 
6520-890-1565 
6520-890-1778 
6520-890-1779 
6520-890-1780 
6520-890-1781 
6520-890-1782 
6520-890-1783 
6520-890-1784 
6520-965-0000 

6520-965-0001 

6520-965-0002 

6520-965-0003 

6520-965-0014 

6520-965-0015 

6520-982-9377 
6520-985-7251 



NOMENCLATURE 

Iodine and Zinc Iodide Glycerite, 2 oz 

Strip, Oxidized, Cellulose, W x 2", 

Syringe, Cartridge, Aspirating, Thumb Ring Handle, Dental 

Bur, Denture Trimming, Steel, 6s 

Band, Copper, Dental, Size 16, 25s 

Band, Copper, Dental, Size 13, 25s 

Brush, Polishing, Dental Handpiece, Natural Bristle, 24s 

Handle, Dental Instrument Point, Chuck Type 

Scaler Point, Dental Morse, No. 2, 6s 

Scaler Point, Dental Morse-Jaquette, No. 3, 6s 

Scaler Point, Dental Morse-Jaquette, No. 4, 6s 

Scaler Point, Dental Morse-Jaquette, No. 5, 6s 

Scaler Point, Dental Morse, No. 6, 6s 

Scaler Point, Dental Morse, No. 7, 6s 

Wheel, Abrasive Diamond, Friction Grip, AHP, Rounded Edge, Ultra 

Speed, 0.160 by 0.050 Inches 

Wheel, Abrasive Diamond, Friction Grip, AHP, Flat Edge, Ultra 

Speed, 0.252 by 0.015 Inches (Safe Side of Wheel on Top) 

Wheel, Abrasive Diamond, Friction Grip, AHP, Flat Edge, Ultra 

Speed, 0.252 by 0.015 Inches (Safe Side of Wheel on Bottom) 

Wheel Abrasive Diamond, Friction Grip, AHP, Ball, Ultra Speed, 

0.045 Inch Diameter 

Wheel, Abrasive Diamond, Friction Grip, AHP, Tapered Cylinder, 

Ultra Speed, 0.060 by 0.325 Inches 

Wheel, Abrasive Diamond, Friction Grip, AHP, Tapered Cylinder, 

Ultra Speed, 0.065 by 0.383 Inches 

Cup, Polishing, Dental Handpiece, Rubber, 24s 

Band, Copper, Dental, Size 15, 25s 



UNIT 


UNIT 


ISSUE 


PRICE 


BT 


1.40 


BX 


4.70 


EA 


2.40 


PG 


3.70 


BX 


.25 


BX 


.25 


PG 


.87 


EA 


1.60 


PG 


1.10 


PG 


1.40 


PG 


1.40 


PG 


1.40 


PG 


1.40 


PG 


1.40 


EA 


.89 


EA 


1.00 


EA 


1.00 


EA 


.59 


EA 


.67 


EA 


.70 


PG 


.74 


BX 


.25 



OCCUPATIONAL MEDICINE 



Large Accident Toll Among Men at the Working Ages 

Statistical Bulletin, Metropolitan Life Insurance Co., 45: 1-3, July 1964. 



Accidents are responsible for a heavy toll of life annu- 
ally among the men who constitute, the major segment 
of the nation's labor force and the large majority of its 
family heads. It is estimated that about 45,000 men in 
the age range 15-64 years died of accidental injuries in 
the United States during 1963, compared with about 
42,600 in 1962. The death rate from this cause rose 
from 79 to 82 per 100,000. 

It is significant that only a relatively small proportion 
of the fatal accidents among men at the main working 
ages — about a fifth — arise out of and in the course of 
employment. In recognition of this fact, the President's 



Conference on Occupational Safety, which held its 
ninth biennial meeting in Washington, D. C. a few 
weeks ago, devoted an entire session to the problem of 
off-t he-job safety. Accidents are a much greater menace 
to the lives of adolescent and young men than any 
other cause. At ages 15-24, accidental injuries take 
considerably more lives than all other causes of death 
together, and account for more than three times the 
combined toll from cancer, homicide, and suicide — the 
causes which rank next in order. Among males at ages 
25-34, accidents still outrank by a wide margin every 
other cause of death. In the next decade of life they 



10 



U.S. NAVY MEDICAL NEWS LETTER 



are in second place, and even at ages 45-64 are ex- 
ceeded only by the cardiovascular diseases and cancer. 
As Table 1 shows, motor vehicles are the major 
source of fatal accidents throughout the main working 
ages, accounting for more than half the total accident 
mortality among males at ages 15-64 combined. At 
ages 20-24, motor vehicle accidents are responsible for 



70 percent of the total, and at none of the other age 
groups under review does the proportion fall below 40 
percent. Occupants of cars — drivers and passengers — 
constitute the large majority of victims throughout the 
working ages; even among men at 55-64 years, occu- 
pants account for three fourths of those fatally injured 
by motor vehicles. 



TABLE 1— MORTALITY FROM SPECIFIED TYPES OF ACCIDENTS 
AMONG MALES, AGES 15 TO 64 

United States, 1961-62 



Average Annual Death Rate Per 100,000 

Age Period — — ZT~ ~. \ \ ' 

(Years) : Accidents : Motor : Fire and : . . . 

; Total : Vehicles : Falls : Drownings* Explosion : Machinery Firearm Aircraft Alt Other 

15.64 77.7 40.6 6.2 4.6 4.0 2.8 2.6 2.2 14.7 

!5_19 77.0 49.5 1.6 10.1 .9 1.4 4.5 .5 8.5 

20-24 106.3 73.9 2.4 6.3 2.3 2.1 3.3 3.3 12.7 

25.34 71.4 40.3 2.7 3.6 3.2 2.2 2.3 3.9 13.2 

35.44 65.2 30.8 5.1 3.2 4.0 2.7 1.9 2.8 14.7 

45.54 75.9 31.5 9.1 3.4 5.8 3.6 2.3 1.4 18.8 

55.64 88.5 35.8 16.4 3.5 6.7 4.1 2.2 .6 19.2 

* Exclusive of deaths in water transportation. 

Although falls rank second as a cause of accidental a year, about 15 million men at ages 15-64 sustain in- 

death, they account for only one twelfth of the total juries which cause restricted activity or require medical 

accident mortality among men 15-64 years of age. The attention, according to data gathered through household 

death rate from this cause in 1961-62 rose without in- interviews by the National Health Survey. Approxi- 

terruption from 1.6 per 100,000 males at ages 15-19 to mately one fifth of the injured men are confined to bed 

16.4 at 55-64 years. In the latter age group, falls con- for at least a day. 
stituted nearly one fifth of the total. It is evident from Table 2 that nearly half of the men 

Drownings and fires each took a little over 5 percent at ages 15-24 are injured annually; the proportion is 
of the total accident mortality among the men in this about 1 out of every 3 at 25-44 years and 1 out of every 
study. Next in order of importance were machinery, 4 at ages 45-64. The table also gives details on the 
firearm, and aircraft accidents. The latter two types, as relative frequency of the major types of accidental in- 
well as drownings, recorded their highest death rates jury. Lacerations and abrasions, sprains and strains of 
under age 35; the two others showed a rising mortality various kinds, and contusions are the leading types 
with advance in age. among men in each age group. Such injuries constitute 

Accidents not only take a large number of lives but two thirds of the total sustained in the age range 15-64 

are also responsible for a heavy toll of nonfatal injuries years. Fractures and dislocations, and burns account 

among men at the main working ages. In the course of for a majority of the other injuries. 

TABLE 2— ESTIMATED ANNUAL FREQUENCY OF CURRENT INJURIES* BY SPECIFIED TYPES 
MALES, AGES 15 TO 64. U.S. NATIONAL HEALTH SURVEY, JULY 1957-JUNE 1961 

Annual Number of Injuries 
Per 1,000 Men at Ages 

Type of Injury 

15-64 15-24 25-44 45-64 



All Injuries 329.0 461.1 319.5 259.9 

Skull fractures and head injuries 1 1.6 21.3 11.2 

Other fractures and dislocations 34.7 45.9 34.4 28.3 

Sprains and strains of back 25.6 20.9 26.4 27.6 

Other sprains and strains 47.9 82.4 39.8 36.9 

Lacerations and abrasions 93.5 130.1 95.0 69.1 

Contusions 54.1 84.9 50.5 39.8 

Burns 14.5 22.0 13.5 11.2 

* Current injuries are those which have lasted less than 3 months, and which have required one or more days of restricted activity or medical 

attention, 
t Too few cases in survey sample to yield reliable results. 

U.S. NAVY MEDICAL NEWS LETTER 1] 



CONTACT DERMATITIS CAUSED BY 
SARAN WRAP 

Raymond A. Osbourn MD, Washington, D. C, 
JAMA 188(13): 141, June 29, 1964. 

Recently, the use of thin plastic films as covering or 
occlusive dressings in therapy with ointments and 
creams, especially hydrocortisone derivatives, has been 
advocated for treatment of several dermatoses. This 
form of therapy is often very beneficial and is becom- 
ing increasingly popular. 

Only a few complications have been reported from 
the use of such films. Among them were discomfort 
from perspiration under the film, a miliaria-like erup- 
tion, and folliculitis. Where hydrocortisone derivatives 
were used, atrophy has also been reported. 

It is our purpose to report a rare complication, i.e., 
contact dermatitis, from the use of a film (Saran Wrap) 
itself. 

Report of a Case. A 30-year-old white male con- 
sulted us on May 2, 1963, because of psoriasis involv- 
ing his scalp, legs and arms. According to his medical 
history, he had had intermittent attacks of psoriasis 
for many years. He had been treated with aminopterin 
and cortisone preparations and had used Saran Wrap 
with local hydrocortisone and related steroid creams. 
Because an area of psoriasis on his right leg was well- 
localized, he was given a steroid cream containing 
triamcinolone, acetonide, neomycin sulfate, gramicidin, 
and nystatin for local application and was told to cover 
the treated area with Saran Wrap for two- to three- 
hour periods every evening. He applied the same 
cream, without covering, to the other scattered areas 
on his arms and legs and he used a scalp lotion con- 
taining resorcinol monoacetate. 

Over the next few weeks, the patient showed im- 
provement of all skin lesions. However, on June 6 he 
returned with an inflamed, swollen, vesicular and exuda- 
tive dermatitis on his right leg, rather sharply limited 
to the area covered by the Saran Wrap. The other 
skin areas on which the same triamcinolone preparation 
was used uncovered were not inflamed. He was ad- 
vised to avoid the Saran Wrap, to use a colloidal 
aluminum acetate (Burow's) solution soak and apply a 
hydrocortisone-neomycin spray. The inflammation 
subsided uneventfully over the next few days. 

A patch with a 1-cm square of Saran Wrap was ap- 
plied to the flexor surface of his left forearm where 
the skin appeared essentially normal. In 48 hours, 
the test site showed redness and vesiculation. The pa- 
tient had continued to use the same triamcinolone 
cream without difficulty on other skin areas. One 
week later he applied this same cream to the right 
leg where the Saran Wrap had been used but no 
reaction was produced. 

Comment. Saran Wrap is a copolymer of vinylidine 
chloride and vinylchloride. Generally, it is considered 
to be relatively inert. The manufacturers advised that 



they did not have a single positive reaction in all the 
skin testing which they did on Saran Wrap as it is com- 
mercially available, nor have they had any skin reac- 
tions reported to them over the years the product has 
been on the market. 

There is a report of skin reactions to epoxy resins 
used as plasticizers and stabilizers in polyvinyl chloride 
films, but these substances, according to information 
received from the manufacturer, are not used in the 
Saran Wrap film. Furthermore, we have not been able 
to find in the literature any reference to reactions to 
the pure polyvinyl chloride or to the copolymer of it 
with vinylidine. 

In view of the large amount of Saran Wrap in past 
and present daily use, it is obvious that skin sensitivity 
to it must indeed be rare. However, because the der- 
matitis in this patient was limited to the area of its 
application and because of the positive patch test reac- 
tion to the product itself, the possibility of skin reac- 
tions to Saran Wrap must be kept in mind when it is 
used as an occlusive dressing for therapy. 

CHROMIUM IN WELDING FUMES AS 
CAUSE OF ECZEMATOUS HAND ERUPTION 

Walter B. Shelley MD, Philadelphia, Pa., JAMA 
189(10); 170-171, September 7, 1964. 

Eczematous eruptions of the palms are a reaction 
pattern of highly diverse etiology. Commonly one may 
find the cause to be due to hypersensitivity to foods, 
drugs, or fungi. In some cases the hyperhidrotic re- 
sponse to psychic tension may be a critical determinant. 
In other instances the cause may elude detection unless 
the physician has a high index of suspicion for all en- 
vironmental exposures, both contactant as well as in- 
halant. We have recently observed a chromium-sensi- 
tive patient in whom inhalation of acetylene welding 
fumes triggered a severe eczematous eruption of his 
palms. 

Report of a Case. A 40-year-old healthy male crane 
operator gave us the history of having had a chronic 
eczematous eruption of both hands for 14 years. At 
the time of onset he had been employed in a factory 
where he worked with a linoleum paste. He had had 
repeated attacks of vesicular lesions on the palmar and 
dorsal surfaces of both hands. Innumerable local prep- 
arations had been tried without real success. One 
month before consulting us the eruption had become 
more severe and was spreading onto his arms and legs. 

The patient was hospitalized. A complete blood 
count, blood urea nitrogen, fasting and postprandial 
blood sugar, and a serologic test for syphilis were 
entirely normal as was a urinalysis. A chest x-ray 
was normal. Nine scrapings for fungi were negative. 
Forty-eight hour patch tests, using 28 suspected sub- 
stances, were performed on the patient. Of the 28, one 
substance, 0.25% potassium bichromate in aqueous 



12 



U.S. NAVY MEDICAL NEWS LETTER 



solution, caused development of a marked vesicular and 
erythematous reaction. 

Systematic steroid and antibiotic therapy, Burow's 
solution compresses, and topical steroid cream led to 
marked improvement within a week. He was dis- 
charged with the diagnosis of eczematous contact der- 
matitis due to chromium hypersensitivity. Strong 
cautionary advice was given that he avoid direct con- 
tact with the following: 

Chrome treated leather (shoes, hat bands, camera 

cases, belts) 

Chromium-plated metal objects (faucets, car 

accessories) 

Zippers 

Zinc chromate paint 

Cement 

Antirust solutions 

Cigarette lighters 

Book matches 

Blue prints 

His course was reasonably satisfactory upon return- 
ing to work. However, two and a half months later he 
suddenly developed an explosive vesicular flare of his 
palms. Careful analysis of all of his activities for the 
preceding day revealed that he had walked by an acety- 
lene welding operation where the fumes were especially 
strong and that he had had appreciable inhalation of 
these fumes. He was then able to recall prior sporadic 
flares of his hand eruption associated with casual ex- 
posure to acetylene welding fumes. 

The palmar exacerbation persisted for several weeks 
despite steroid therapy. Now, however, with the added 
precaution of avoiding welding fumes, the patient has 
been able to keep his hands relatively clear of derma- 
titis. 

Comment. Chromium is the major allergen of indus- 
try today. Its highly diverse and, at times, occult 
distribution explains the phenomenal persistence of the 
eruption in some individuals. Considered largely con- 
tactant it has recently been shown to be a hazard even 
in welding fumes. Thus, Fregert and Ovrum reported 
the case of a welder who experienced repeated episodes 
of contact dermatitis of the face. He was found to be 
sensitized to the chromium vaporized from the chromi- 
um welding rod with which he worked. Removal from 
his welding job led to a complete cure. Possibly, such 
a chrome sensitivity would explain the urticaria and 
asthma experienced by another patient whenever ex- 
posed to acetylene welding fumes. 

Although industry has been fully cognizant of the 
varied chemical compositions of welding fumes, in- 
sufficient instruction has been given to the chrome- 
sensitive individual regarding the very real hazard of 
welding. Some welding rods contain as much as 18% 
chromium so that the circumambient environment of 
any welding operation becomes saturated with allergen. 
Work with chromium steel alloys is another obvious 
danger for the chrome-sensitized person. 



Significantly in our patient, casual exposure to the 
fumes caused a severe flare of his dermatitis. The 
chromium is viewed in this instance as an inhalant 
allergen, but in closed shop operations one could readi- 
ly see that all benches, tools, clothing, etc., would be 
impregnated with a chromium mist. 

PATCH TESTING 

George H, Kostant MD, New York, N. Y., Jour of 

Occupational Medicine, 6(9): 381-382, Sept 1964. 

Patch testing is a valuable tool in the diagnosis of 
allergic contact dermatitis when the indications and 
contraindications are properly understood, and when 
the tests are performed and interpreted correctly. 

Approximately 80% of all cases of industrial contact 
dermatitis are caused by exposure to primary irritants 
such as soaps, detergents, alkalis, acids, certain sol- 
vents, greases, some petroleum products, paints, etc. 
These are substances which will affect all persons ex- 
posed when the intensity and duration of that exposure 
is sufficient. Patch testing with such substances is of 
no value and may even prove dangerous. 
.. Patch testing should be used only to establish a diag- 
nosis of allergic etiology when the location and mor- 
phology of the cutaneous process suggests a contact 
dematitis. Patch testing is most valuable when the 
worker is the only one in a group of individuals who 
develops a contact dermatitis after exposure to a par- 
ticular substance. 

Patch testing should not be performed in the pres- 
ence of an acute dermatitis but should be deferred until 
the acute process has subsided. Failure to delay patch 
testing may provoke an exacerbation of the dermatitis 
that may be more intense and of longer duration than 
the initial episode. 

Because patch testing may itself produce sensitization 
in susceptible individuals, patients should not be tested 
with allergens which they have not already contacted, 
particularly if these are substances that they may en- 
counter subsequently in the course of their daily life. 
Testing should be limited to substances with which they 
have had the kind of contact likely to produce the ob- 
served dermatitis. Wholesale testing with all possible 
allergens present in the work environment, regardless 
of the likelihood of contact with them by the worker in- 
volved is to be deplored. Obviously, even if a worker 
should prove to be sensitive to an allergen, it cannot 
be incriminated in the etiology of his contact dermatitis 
unless it can be shown that he actually came into con- 
tact with it. 

Patch testing should not be performed as a prerequi- 
site for employment since it does not satisfactorily 
indicate which workers are likely to become sensitized. 

Technic. Patch tests are performed by placing a 
sample of the suspected allergen, usually in the state 
in which it is encountered in the course of the work 
exposure, so that it will remain in contact with a small 
area of normal skin for a 24- to 48-hour period. Rel- 



U.S. NAVY MEDICAL NEWS LETTER 



13 



atively nonhairy areas such as the volar surface of the 
forearm or the interscapular region of the back are 
preferred. The area selected for testing should not be 
shaved or pretreated in any. way. As many as 18 or 20 
individual patches may be applied simultaneously when 
the back is used. 

In the case of liquids, a 1-cm. square of unglazed 
white cotton cloth or blotting paper is saturated with 
the suspected allergen. The moist square is applied 
to the skin and covered by a round piece of cellophane, 
2-cm. in diameter which, in turn, is covered by a 
larger adhesive patch. Additional adhesive strips may 
be used to reinforce the adhesive patch when necessary. 

When the suspected liquid allergen is a fat solvent or 
of such nature that it may be suspected of having a pri- 
mary irritant action, it should be diluted with an equal 
part of either olive oil or fight mineral oil before ap- 
plying it to the patch. Water-soluble substances should 
be diluted with water to a concentration below that 
known to be primarily irritant. Tables of permissible 
concentrations are available in such texts as that of 
Schwartz et al. 

Powdered substances are applied directly to the cot- 
ton or blotting paper square and then moistened with 
water. Fabrics, papers, plastic materials, and other 
solids may be applied directly to the skin and moistened 
with water. In both instances, the patch is covered by 
the occlusive cellophane-adhesive covering described 
above. 

Patch tests are read in 24-48 hours. However, the 
patient should be cautioned to remove it promptly if he 
becomes aware of more than minimal itching, pain, or 
burning in the region of the patch. Failure to do so 
may result in ulceration and scarring. 

The reaction is not read until about 15 min. after the 
patch is removed, to allow any transient effects of 
removal of the tape to disappear. The intensity of the 
reaction is graded according to the following 5-point 
scale: negative, no reaction; t-f-, erythema; 2-)-, ery- 
thema and edema; 3-|-, erythema, edema, papules, and 
an occasional vesicle; and 4-f-, many vesicles which in 
some cases may cause denudation of the area of ex- 
posed skin. 

A positive test confirms the sensitivity of the indi- 
vidual to that allergen, the intensity of the reaction 
reflecting the degree of the sensitivity. Assuming that 
his work involved exposure to it in such a manner that 
it could be the cause of his contact dermatitis, the 
positive test incriminates that allergen as the etiologic 
agent. Arrangements should then be made to protect 
him from all further contacts with this material by 
either removing it entirely from his work environment 
or instituting adequate measures to obviate his contact 
with it. 

HAZARDS TO HEALTH: MIXTURES OF 
HOUSEHOLD CLEANING AGENTS 

Harry C. Faigel MD. Boston Poison Information Center, 



New England Jour of Med, p 618, Sept 17, 1964. En- 
vironmental Health Letter, 4(1), Oct 15, 1964. 

Mixing household cleaners is a common practice 
among American housewives. Experimenting and un- 
conscious of the fumes that some of these mixtures 
release, they hope that their own formulation will clean 
better than a single commercial product will. Some 
commercial cleaners are themselves mixtures of other- 
wise safe ingredients, until a homemade additive 
changes them into a toxic gas, usually chlorine or am- 
monia. Poisoning by mixtures of homemade cleaners 
is usually from inhalation of the reaction products. 
The incident often occurs in a poorly ventilated, closed 
space, and appears to happen more often in the winter 
when windows are closed and ventilation is minimal, 
and when rooms are heavily soiled. During a period 
of 60 days in the winter of 1963, 45 calls were received 
at the Boston Poison Information Center regarding 
adult poisonings. Four of these were for inhalation of 
gases produced by homemade cleaning mixtures. The 
most common combinations used are mixtures of sodi- 
um hypochlorite and ammonia or vinegar. Sodium 
hypochlorite and vinegar react and produce large 
volumes of chlorine gas. When sodium hypochlorite is 
mixed with ammonia large volumes of ammonia gas are 
given off. 

PREVENTION OF HEAT ILLNESS IN 
THE INDUSTRIAL ENVIRONMENT 

Industrial Hygiene News Report, VII(ll), Nov 1964. 

In industrial environments, heat illness can be pre- 
vented by regulating work and rest cycles for workers 
to insure that the total heat load (environmental and 
metabolic) is maintained within tolerable limits, ac- 
cording to David Minard, MD, Chairman of the De- 
partment of Occupational Health, University of Pitts- 
burgh (Pittsburgh, Pa. 15213). Speaking at a meeting 
of the Industrial Medical Association of Pittsburgh- 
Cleveland on September 25, Dr. Minard classified heat 
illness into five categories: imbalance of water and 
electrolytes (salt and/or water depletion heat exhaus- 
tion); circulatory insufficiency (heat syncope); skin 
disorders (heat rash and anhidrotic heat exhaustion); 
thermoregulatory failure (heat stroke and heat hyper- 
pyrexia); and psychological disorders (acute and chronic 
heat fatigue). 

To assess heat stress, Dr. Minard named three in- 
dices that may be used — the Effective Temperature 
Scale, the Heat Stress Index of Belding and Hatch, and 
the Predicted 4-Hourly Sweat Rate — but he stressed 
that a valid index of heat stress must weigh physical 
factors of radiant heat, air temperature, humidity, and 
air movement in terms of their combined effects on 
physiological functions. Factors which reduce heat 
tolerance are lack of heat acclimatization, salt and/or 
water depletion, improper clothing, aging, obesity, 
and clinical disease of the circulatory and cutaneous 



14 



U.S. NAVY MEDICAL NEWS LETTER 



systems, he said, and added that patients on low salt 
diets or under treatment with hypotensive and diuretic 
drugs are particularly susceptible to heat death. 

Ways of preventing heat strain in workers, when 
engineering methods such as radiant screening and 
ventilation are impractical, were given as follows: 
(a) select heat tolerant workers; (b) graduate exposure 
to insure maximum acclimatization; (c) maintain water 
and salt balance; (d) regulate work-rest cycles; (e) pro- 
vide cooled recovery rooms; and (f) provide heat pro- 
tective clothing which employs the principles of re- 
flection, insulation, and ventilation. 

X-33 WATER REPELLENT 

USDHEW, Food and Drug Administration, Wash. 25, 
D. C. for release August 30, 1964. 

The Food and Drug Administration, Department of 
Health, Education, and Welfare, today asked State and 
other local health and safety officials, including fire 
departments, for help in removing from the market 
"X-33 Water Repellent," an extremely flammable 
masonry water proof er. 

Food and Drug Commissioner George P. Larrick 
said that "X-33" has caused three deaths and over 
30 injuries through flash explosions. 

To date, the Government has siezed almost 500 ship- 
ments of the misbranded "X-33". However, it is esti- 
mated that up to 1,200 shipments of the product may 
still be in possession of hardware stores, lumber yards, 
filling stations, auto supply houses, grocery stores, drug 
stores, and feed and grain dealers, etc. 

The Wilmington Chemical Corporation has notified 
FDA that it is financially unable to recall the shipments 
of "X-33" still on the market. "This material repre- 
sents a continuing hazard to the public," Mr. Larrick 
said. "We therefore recommend that all stocks of the 
extremely flammable "X-33" in a misbranded condition 
should be destroyed under the supervision of local fire 
authorities and that State and other local officials take 
whatever action is available to them to order destruc- 
tion," he added. 

FDA said that the first "X-33" death was that of an 
Amboy, Minnesota housewife in May 1963. She had 
painted her basement walls with "X-33" and sat down 
to rest. The windows were reported opened and no 
pilot lights were on, but an explosion and flash fire 



occurred nevertheless. Her husband, on the floor 
above, was severely burned and the roof blown off the 
attached garage. The housewife died two days later. 
The second death was that of an Ames, Iowa, woman 
who suffered fatal injuries from an explosion and flash 
fire while using "X-33" on her basement walls in 
September 1963. The latest "X-33" fatality involved a 
Gainesville, Georgia man who died of burns received 
while using "X-33" in a basement on June 4, 1964. 

FDA said that "X-33" first appeared on the market 
early in 1962. As then manufactured, it had a flash- 
point (the lowest temperature at which the fumes or 
vapor from a liquid will ignite when exposed to a flame 
or spark) of 40 degrees below zero Fahrenheit. The 
product manufactured since July 1963 has been 
changed and has a flashpoint of 73 degrees above zero 
Fahrenheit. However, little of this less hazardous prod- 
uct reached the market. The labels of the two products 
are indistinguishable. 

The extremely flammable "X-33" as distributed by 
the Wilmington Chemical Corp. of Chicago, 111., was 
in violation of the Federal Hazardous Substances Label- 
ing Act because it did not bear, proper warning regard- 
ing the hazard of the product the Agency said. The 
firm was notified that in order to comply with the Act, 
the "X-33" label must bear a stringent warning state- 
ment that would include (among other warning infor- 
mation) the following: 

"DANGER — EXTREMELY FLAMMABLE- 
VAPORS HIGHLY EXPLOSIVE*** A spark 
from any source, even at remote points, may 
detonate the vapors. ***The potential hazard 
from the use of this product is so great, it is 
recommended the user, before applying the ma- 
terial, consult with a professional expert in han- 
dling such highly hazardous materials to mini- 
mize the chance of personal injury or property 
damage." 

While the "X-33" produced under a different formula 
since July 1963 is not as flammable as the older pro- 
duct, labels on the cans do not indicate which product 
is which, FDA said. 

Mr. Larrick recommended that persons who volun- 
tarily decide to get rid of their stocks of "X-33" should 
consult with their local fire department regarding safe 
procedures for destroying such material. 



RESERVE 




MEDICAL SCHOOL GRADUATES TASTE 
NAVY LIFE ON RIVER TRIP * 

How does a medical school graduate know if he 
wants to spend his internship years in the United States 
Navy? 



SECTION 



Probably the best way to find out is to go aboard a 
ship to get a first-hand look at Navy life afloat and 
that's just what 39 Louisiana State University School of 
Medicine students have done. 

In order to get an even better perspective on the 



U.S. NAVY MEDICAL NEWS LETTER 



3 5 



Navy, they brought their wives, fiancees or girl friends. 

THE STUDENTS' five-hour trip down the Missi- 
ssippi River aboard the destroyer escort USS Huse is 
part of the subtle but determined recruiting campaign 
aimed at attracting medical students today. 

Because medical schools don't graduate nearly enough 
students to meet the needs of the military services, 
private hospitals, public hospital and federal health 
facilities, the law of supply and demand has taken over 
with the most astute recruiter reaping the benefits. 

Capt. Ralph K. Brooks of the Navy Medical Corps, 
who arranged the cruise, is a firm believer in letting 
the medical students get a good, hard look at what mili- 
tary service means for the young doctor. 

HE FREELY ADMITS there are pros and cons re- 
garding the benefits of spending several training years 
in the service before entering private practice. 

Dr. Brooks emphasizes, however, that although each 
student must make his own decision with individual 
career goals in mind, it is equally essential that every 
possibility be thoroughly investigated. 

"The years immediately after the completion of 
medical school are among the most important for a 
doctor," he said. "The experience gained often has 
a lot to do with the area a doctor specializes in and 
his level of competence. 

"BECAUSE WE UNDERSTAND this, the Navy is 
glad to give these young people an objective look at 
the kind of training we can offer them," he said. 

The cruise aboard the destroyer escort was high- 
lighted by an engine room to wheel-house tour of the 
ship and a trip through a traditional Navy chow line. 
Eighth Naval District officials are now wondering if 
their "chow" has some special recruiting magic. 
Almost everyone went back for seconds. 

NAVY DOCTORS HOLDING SEMINAR 
ON LEPROSY * 

Leprosy is so rare in the United States today that 
most doctors wouldn't know it if they saw it. At least 
not in the early stages. 

That's the reason for an intensive three-day seminar 
on leprosy for a group of U. S. Navy doctors being held 
here and at the U. S. Public Health Hospital in Car- 
ville, the only leprosarium in the continental U, S. 

Military concern about leprosy has increased with the 
growing U. S. involvement in Southeast Asia, according 
to Captain Ralph K. Brooks, district medical officer of 
the Eighth Naval District, who arranged the seminar. 

"Although leprosy is almost unknown in this country, 
it's not uncommon in those areas of Asia where our 
servicemen are being sent." he said. 



* Submitted by Headquarters, Sth Navat District, New Orleans, La. 
From New Orleans States — Hem of 14 and 18 November 1964, by 
permission of Mr. Allan Kate, author or these articles. 



DR. BROOKS said the lack of knowledge about 
leprosy recently was brought home when a Marine in 
California underwent treatment a year for a "skin dis- 
order," before it was properly diagnosed as Hansen's 
Disease, the term used to avoid the emotional conno- 
tations of the word leprosy. 

Because early diagnosis and treatment of Hansen's 
disease can arrest its symptoms and prevent the tin- 
sightly and irreversible damage that historically made 
the victims outcasts, Dr. Brooks suggested to the Navy 
Surgeon General that skin specialists from major Navy 
hospitals across the U. S. come to see what leprosy 
looks like in its many stages. 

Attending the meeting here are medical delegations 
from Navy hospitals in San Diego, Calif.; Great Lakes, 
III.; Philadelphia, Pa.; Jacksonville, Fla.; Bethesda, Md.; 
Beaufort, S. C, and Camp Lejeune, S. C. 

DURING THEIR visit to Carville, the naval physi- 
cians met with doctors at the leprosarium, made rounds 
to observe patients and generally began their clinical 
acquaintance with the age-old affliction. 

The chief point emphasized was that medicines 
available today are effective enough in arresting leprosy 
to permit many patients to lead almost normal lives. 

Carville physicians noted that some of their patients 
are part-time students at Tulane University, while 
others attend Louisiana State University in Baton 
Rouge. 

THE NAVAL doctors were told that although there 
is no cure for Hansen's disease at this time, sulfone 
drugs will arrest it promptly, often before grossly 
noticeable lesions have formed. 

"Most American doctors, even those in the military 
service, will never see a case of leprosy in a career 
of active practice," observed Dr. Brooks. "However, 
in a crisis-ridden world no military physician ever 
knows what tomorrow will bring. 

"The purpose of this meeting," he said, "is to be 
certain that leprosy will never come as a surprise to 
Navy doctors." 

RESERVE DENTAL OFFICERS SEMINAR 

The Commandant, Ninth Naval District sponsored a 
one-day Reserve Dental Officer Seminar at Headquart- 
ers, Ninth Naval District on 2 December 1964. Lec- 
turers presented the latest information on topics of 
vital interest to Naval Reserve Dental Officers. Table 
clinics were presented by members of Naval Reserve 
Dental Company 9-6 of Evanston, Illinois. In addition 
to the Inactive Reserve Dental Officers, the table 
clinic portion of the program was attended by 100 Den- 
tal Officers from Administrative Command and the 
U.S. Naval Hospital, Great Lakes, Illinois. One re- 
tirement point was credited to the 70 Inactive Reserve 
Dental Officers attending the Seminar — From Com- 
mandant, Headquarters, Ninth Naval District, Great 
Lakes, 111. 



U.S. NAVY MEDICAL NEWS LETTER 



MISCELLANY 



GENERAL HOSPITALS ASSUME INCREASED 

IMPORTANCE IN PSYCHIATRIC 

PATIENT CARE 

The general hospital is now a facility of major sig- 
nificance in providing treatment for mental illness, ac- 
cording to figures announced by the Public Health 
Service, U. S. Department of Health, Education, and 
Welfare. 

A total of 1,005 general hospitals in the United 
States admit psychiatric patients for diagnosis and treat- 
ment, according to preliminary results of a current hos- 
pital survey completed by the National Institute of 
Mental Health and the American Hospital Association. 
In the most recent 12-month period, the hospitals 
report that they discharged 412,459 psychiatric patients. 
Public State and county mental hospitals, by contrast, 
admitted 285,244 patients in 1963. 

The figures provide additional evidence that the treat- 
ment of the mentally ill in their home communities has 
increased sharply. They reveal that many more general 
hospitals provide psychiatric care than earlier studies 
based on incomplete data indicated. 

In reporting the 412,459 discharges, the hospitals 
used the most recent 1 2-month period for which statis- 
tics are available, in most instances for 1963. The last 
previous estimate, of 224,000 patients discharged in 
1962, was based on reports to NIMH by only 392 of the 
585 general hospitals then known to admit psychiatric 
patients. 

Hospitals surveyed include those listed by the Amer- 
ican Hospital Association as either general hospitals 
(958). infirmaries (40), or general hospitals for children 
(7), all of which provide treatment of physical and 
mental illnesses. Approximately 45 percent of the total 
maintain separate psychiatric units within the hospital 
and the others admit psychiatric patients to their general 
medical service. 

Many of these hospitals will be eligible for Federal 
grant-in-aid construction funds appropriated under the 
Community Mental Health Centers Act of 1963, as 
component parts of comprehensive community mental 
health centers. 

General hospitals are assigned special priority in the 
statute, as potential sponsors of community mental 
health centers, if they are a part of a coordinated net- 
work of treatment services providing the essential ele- 
ments of comprehensive care and treatment of the men- 
tally ill. 



To stimulate establishment of community centers, 
Congress appropriated $150 million for Federal aid in 
financing up to two-thirds of the construction costs of a 
center. Of that total, $35 million is available for Fed- 
eral grants in the next year. 

Preliminary tabulations from the new survey show 
that California has the largest number of general hospi- 
tals admitting psychiatric patients (71). These dis- 
charged 44,750 such patients in a recent 12-month 
period. 

Pennsylvania had 70 hospitals admitting psychiatric 
patients and 22,218 discharges.; Texas 65 hospitals and 
21,558 discharges. Although New York had only 61 
hospitals admitting psychiatric patients, 54,247 patients 
were discharged. 

Final results of the AHA-NIMH survey will appear 
in a forthcoming issue of "Hospitals," the journal of the 
American Hospital Association. An accompanying 
analysis and tables will provide information on the hos- 
pitals, by size, location and type of service offered. — 
News Release, Public Health Service, DHEW, 7 Nov 
1964. 

AMERICAN BOARD OF OBSTETRICS 
AND GYNECOLOGY 

, Candidates who have participated in the Part I (writ- 
ten) examination of this Board given on December 11, 
1964, will be notified of the results of their examination 
on or before February 1, 1965. 

Applications for the Part I (written) examination to 
be given on luly 2, 1965, will be accepted in the office 
of the Secretary during the months of January and 
February. All applications postmarked after February 
28th will be returned to the sender. Application forms 
and Bulletins of the Board may be obtained by writing 
to the office of the Secretary, — Clyde L. Randall MD, 
American Board of Obstetrics and Gynecology, 100 
Meadow Road, Buffalo, New York 14216. 

Servicemen applying for the Part I examination are 
requested to submit with their application, the name of 
their Commanding Officer. 

Diplomates of this Board are requested to keep the 
Secretary's office informed of any change in address. 

INDEX MEDICUS SUBSCRIPTION PRICE 
TO BE RAISED IN JANUARY 

The National Library of Medicine has announced that 
increased printing costs have necessitated an increase 



U.S. NAVY MEDICAL NEWS LETTER 



17 



in the annual subscription rates for the Index Medicus. 
Free distribution of the publication will be discontinued 
following the December issue. 

Effective January 1965, the annual subscription rates 
will be $40 domestic and $49 foreign. Orders should be 
sent to the Superintendent of Documents, U. S. Govern- 
ment Printing Office, Washington, D. C. 20402. It is 
suggested that subscription orders be placed as far in 
advance as possible. 

The Cumulated Index Medicus, published by the 
American Medical Association, includes all the informa- 
tion carried in the monthly issues. Further information 
on CIM may be obtained from the Circulation and 
Records Department of the AM A at 535 Dearborn 
Street, Chicago, Illinois. 

OAK KNOLL RESIDENT WINS 
COVETED AWARD 

LCDR A. C. Rolen, third-year resident in Obstetrics 
and Gynecology, won the Kimbrough Award for the 
best resident paper presented at the Annual Armed 
Forces OB-Gyn Seminar held at Andrews AFB Hospital 
in Washington, D. C, from 26-29 October 1964. 

Dr. Rolen's paper, titled "Rudimentary Uterine Horn, 
Obstetrical and Gynecological Implications", was based 
on studies of a case of this rather rare congenital anom- 
aly which he saw at USNH, Oakland last January and 
on four well-documented previously unreported cases 
from personal experiences of other Oak Knoll staff 
members. It was illustrated with slides of x-ray studies, 
photographs made at surgery, and sketches of the anom- 
aly. In preparation for his presentation, Dr. Rolen re- 
viewed ail known American literature on the subject — 
the diagnosis, care of, and conclusions reached in each 
case, only 65 of which have been seen in the last 50 
years. 

Dr. Rolen's award — an appropriately worded docu- 
ment and $150 in cash — was presented by Dr. Robert 
A. Kimbrough, Medical Director of the American Col- 
lege of Obstetrics and Gynecology, for whom it is 
named. This is the first time the award has been pre- 
sented. 

Three of the award-winning resident's Oak Knoll 
colleagues were there to applaud his achievement. They 
were CAPT J. P. Semmens, Chief of Obstetrics and 
Gynecology, who appeared on the program with a paper 
on "Teenage Pregnancy and Its Special Implications", 
LCDR B. D. Biele, and LCDR N. K. Takaki. 

Dr. Rolen earned his MD at the University of Ten- 
nessee College of Medicine, Memphis, in March 1958. 
He served as medical officer on the staff of Commander, 
Landing Squadrons 1 and 9 in the Pacific and at U. S. 
Naval Hospital, Yokosuka, Japan, before reporting to 
Oak Knoll on 23 August 1962.— From: RADM Cecil 
L. Andrews MC USN, CO, USNH, Oakland, California 
and DMO, 12th Naval District, San Francisco, Cali- 
fornia. 



THE TWELFTH GENERAL CONFERENCE 
ON WEIGHTS AND MEASURES 

The 12th General Conference on Weights and Meas- 
ures, held at the International Bureau of Weights and 
Measures, Paris, France, October 6-13, 1964, was at- 
tended by representatives of 37 different nations. In- 
cluded were leaders from the standardizing laboratories 
of the major technologically advanced nations. Among 
the more significant accomplishments of the meeting was 
the designation of an atomic definition of the second — 
the international unit of time. This definition is tempo- 
rarily based on an invariant transition of the cesium 
atom. 1 

Dr. Allen V. Astin, Director of the National Bureau 
of Standards, headed the American delegation to the 
Conference. This delegation included A. G. McNish, 
Chief, Metrology Division, NBS, and, as advisory mem- 
bers from the State Department, Dr. Abraham Fried- 
man, Miss B. C. Gough, Mr. K. N. Skoug, Jr., J. A. 
Bovey, Jr., and Dr. Edgar L. Piret. 

The liter, defined up to now as the volume occupied 
■by one kilogram of water, differs from a cubic decimeter 
by about 28 millionths, and this discrepancy — slightly 
out of line with other international measurement units — 
has frequently caused difficulty in precision work. The 
Conference therefore abrogated the old definition, and 
made the liter merely a special name for the cubic deci- 
meter. The resolution in which this action was taken, 
however, pointed out that the word "liter" should not be 
used to express the results of volume measurements of 
high precision. 

In another resolution, the Conference recognized that 
the curie has been used as the unit of activity of a 
radio-active substance in a great many countries for a 
long time, and that in the International System of Units 
the unit of activity is the second to the power minus one 
(s^ 1 ). It was therefore agreed that the curie should be 
retained as a special unit, with its assigned disintegration 
value of 3.7 x 10 ln s -1 . The symbol formally established 
for the curie is "Ci." 

In other work, the Conference moved forward in ap- 
proving the research of several of the member nations 
in extending electrical measurements into the high fre- 
quency region, and in broadening the bases for the 
Practical International Temperature Scale. During the 
Conference, the delegates visited the International 
Bureau's new ionizing radiation laboratory which had 
been formally opened the week preceding the Con- 
ference. 1 



BUMED NOTICE 5100 



13 November 1964 



Subj: NFPA Poster, "Safe Practice in Anesthetizing 
Locations" 

Ref: (a) BUMEDINST 5100. IB of 24 Nov 1959 

1 For further details, see NBS Tech News Bull 48, No. 12(December 
1964), (Note to Editors: A release on the new time standard 
dated Oct 9, 1964, and numbered STR-3081, is available to editors 
upon request. A release on the new laboratory dated Oct 1964 and 
numbered STR-3086 is also available upon request.) 



18 



U.S. NAVY MEDICAL NEWS LETTER 



1. Purpose. To provide a poster to serve as a contin- 
uing reminder to personnel working in anesthetizing lo- 
cations of the safety measures that must be observed in 
these areas. 

2. Background. Subject poster, which is abstracted 
from NFPA Pamphlet No. 56, "Flammable Anesthetics 
Code," highlights the safe practice that must be ob- 
served in anesthetizing locations where flammable agents 
are used. NFPA Pamphlet No. 56 is an enclosure to 
reference (a). 

3. Action. It is recommended that subject poster be 
displayed in each area in which the following flammable 
anesthetic agents are used: cyclopropane, divinyl ether, 
ethyl ether, trifluoroethyl ether, ethyl chloride, and 
ethylene. Ships or stations which have not received 
copies of subject poster, or commands which need addi- 
tional copies, may request them from the Bureau of 
Medicine and Surgery (Code 7224) specifying the num- 
ber required. 

S/E. C. KENNEY 

EIGHT NEW AND REVISED 
CORRESPONDENCE COURSES 

In an effort to keep abreast of rapid technological 
developments and in order to better cope with changing 
training requirements, the Correspondence Training Di- 
vision of the Naval Medical School will shortly release 
eight new and revised correspondence courses. The 
following courses will be released: 

Hematology 

Biochemistry 

Bacteriology and Mycology 

Urinalysis, Gastrointestinal Contents and 
Endocrinology 

Serology 

Tropical Medicine in the Field 

Pathologic Anatomy Technique 

Manual of the Medical Department 
Applicants are desired for the course in Hematology 
at this time. Applications for the other above-listed 
courses should be held in abeyance pending notification 
of availability in the Medical News Letter and other 
service journals. — From CAPT J. H. Stover, Jr., CO, 
U. S. Naval Medical School, Bethesda, Md. 



BUMED NOTICE 6710 



6 November 1964 



Subj: Federal Food, Drug, and Cosmetic Act as 
Amended and General Regulations for Its En- 
forcement, Title 21, Part 131, Warnings Re- 
quired on Drugs and Devices for Over-The- 
Counter Sale 

1 , Purpose. To advise of a recent amendment to sub- 
ject Regulations pertinent to Acetophenetidin (phenace- 
tin)-containing preparations when dispensed to person- 
nel without the written prescription of a physician or 
dentist. 

2. Background. On the basis of studies made by the 
Food and Drug Administration, the Commissioner of 



Food and Drugs has concluded that it is necessary for 
the protection of users that the label and labeling of all 
acetophenetidin (phenacetin)-containing preparations 
bear a warning statement to the following effect: 

WARNING — This medication may damage the kid- 
neys when used in large amounts or for 
a long period of time. Do not take 
more than the recommended dosage, 
nor take regularly for longer than 10 
days without consulting your physi- 
cian. ■ 

3. Action. Effective immediately in all facilities where 
acetophenetidin (phenacetin) -containing drugs, includ- 
ing APC tablets, are prepackaged or dispensed, except 
on the prescription of a physician or dentist, the above 
warning shall appear on the label of the item con- 
tainers) . 

4. Cancellation. This Notice is canceled upon imple- 
mentation of the above action, or for record purposes 30 
June 1965. 

S/E. C. KENNEY 

NAVAL MEDICAL RESEARCH REPORTS 

U. S. Naval Medical Research Institute, National Naval 
Medical Center, Bethesda, Md. 

1. Propagation of Rickettsiella Popilliae (Dutky and 
Gooden) Philip and Rickettsiella Melolonthae 
(Krieg) Philip in CellCultures: MR 005.09-1200.02 
Report No. 18. 

2. A New Babesia in the Indian Bandicoot: MR 
005.09-1606.01 Report No. 7, June 1964. 

3. The Effect of Immediate Sympathectomy on Tissue 
Survival Following Experimental Frostbite: MR 
005.01-0021.01 Report No. 4, July 1964. 

U. S. Naval Medical Research Unit No. 3, Cairo, Egypt 

1. Biological Disposition of Some Antimonyl Antibil- 
harzial Drugs: Sodium Antimony-2, 3-Meso-Dimer- 
capto-Succinate (Astiban) in Animals Infected with 
Schistosoma Mansoni: MR 005.09-1035.13, July 
1964. 

2. Tinea Capitis: A Study of 400 Egyptian Cases: MR 
005.12.101.17, July 1964. 

3. Hemoglobin Variants and Blood Groups Among 
Nubians in Egypt, U. A, R.: MR 005.06-0051.2, 
September 1964. 

4. Possible Factors Associated With the Relatively Low 
Prevalence of Dental Caries Among Egyptians 1. 
Relationship of Enamel Solubility to Caries Expe- 
rience: MR 005.12-5001.6, September 1964. 

U. S. Naval Medical Field Research Laboratory, Camp 
Lejeune, N. C. 

1. A preliminary Evaluation of NuV Energy Bar: MR 
005.12-6001.6, October 1964. 



U.S. NAVY MEDICAL NEWS LETTER 



19 



U. S. Naval Air Development Center, Aviation Medical 
Acceleration Laboratory, Johnsville, Penna. 

1. Simulation and Effects of Severe Turbulence on Jet 
Airline Pilots: MR 005.13-0005.10 Report No. 1, 
August 1964. 

2. Displacement and Durational Characteristics of 
Lever Pressing Under a Variable Ratio Schedule and 
Subsequent Extinction: MR 005.13-0002.16 Report 
No. 14, September 1964. 

U. S. Naval Medical Research Laboratory, U, S. Naval 
Submarine Base, New London, Conn. 

1. Calcium Phosphorus Metabolism in Man During 
Acclimatization to Carbon Dioxide: MR 005.14- 
3002-1.10, February 1964. 

2. Respiratory Acclimatization to Carbon Dioxide: 
MR 005.14-3002-1.11, February 1964. 

3. Effect of Body Position on Meriodional Variations 
in Scotopic Acuity: MR 005.14-1001-1.32, Febru- 
ary 1964. 

4. Acid-Base Balance and Blood and Urine Electro- 
lytes of Man During Acclimatization to Carbon 
Dioxide: MR 005.14-3002-1.12, March 1964. 

5. A Factor Analytic Study of Three Signal Detection 
Abilities: MR 005.14-1001-2.16, April 1964. 

6. Reaction Time Under Three Viewing Conditions: 
Binocular, Dominant Eye, and Non-Dominant 
Eye: MR 005.14-1001-1.33, May 1964. 

7. Visual Requirement Failure by Candidates Report- 
ing for Basic Submarine Training During 1963: 
MR 005.14-2001.3.4, May 1964. 

8. A Review of the Rationale of the Visual Standards 
for Submarine Duty: MR 005.14-2001-4.07, May 
1964. 

9. Interactions Among Bandwidth, Center Frequency, 
and Type of Distortion in Speech Intelligibility: 
MR 005.14-1001-4.04 Report No. 432, June 1964. 

10. Tritium Activity, Monitoring, Personnel Protection, 
and Decontamination: MR 005.14-3002-4.14 Re- 
port No. 434, June 1964. 

U, S. Naval Hospital, Clinical Investigation Center, 
Oakland, Calif, 94614 

1. Humpty Dumpty in Uniform, April 1964, 

2. Clinical Aspects of a Serologic Study of Psychoses: 
MR 005.12-2101.1, July 1964. 

3. Serological Distinction Between Functional Psycho- 
ses: MR 005.12-2101.1, July 1964. 

4. Urinary Steroids in Neurotic-and Manic-Depression: 
MR 005.12-2101.1, July 1964. 

5. Hyperlacticacidemia in Patients with Septic Abor- 
tions: MR 005.12-1408.8, October 1964. 

6. The Imagery of Visual Hallucinations: MR 005.12- 
2101.2, October 1964. 

U. S. Naval School of Aviation Medicine, Naval Avia- 
tion Medical Center, Pensacola, Fla. 
1. A Threshold Caloric Test: Results in Normal Sub- 
jects: MR 005.13-6001 Subtask 1 Report No. 72, 
July 1962. 



2. The Elevator Illusion: Apparent Motion of a Visual 
Target During Vertical Acceleration: MR 005.13- 
6001 Subtask 1 Report No. 89, October 1963. 

3. Interdependence Among Some Factors Associated 
with Coronary Heart Disease: MR 005.13-3001 
Subtask 2 Report No. 9, March 1964. 

SPACE AND ASTRONAUTICS 
ORIENTATION COURSE 

This course has been established to give senior officers 
of the Navy a better understanding of this new technol- 
ogy, its application to naval warfare, and its important 
role in national defense. The course is in consonance 
with the Navy's global mission and emphasizes the sig- 
nificant impact of astronautics on seapower. It is 
primarily designed for those senior officers who have 
not had the opportunity to gain knowledge of astro- 
nautics and current Space programs. A highlight of the 
course is a visit to the space vehicle launch and control 
facilities at Point Arguello Naval Missile Facility and at 
Vandenberg Air Force Base. 
Location: U. S. Naval Missile Center, Point Mugu, 

California 
Duration of Course: Four days (Tuesday-Friday) 
Convening dates of Course: 

23 February 1965 

16 March 1965 

20 April 1965 

11 May 1965 
8 June 1965 

13 July 1965 

14 September 1965 
26 October 1965 
16 November 1965 

7 December 1965 
BUMED Quota: One for each class 
Deadline Date to Apply: Immediately for the 23 Feb- 
ruary course, and six weeks 
in advance for the remaining 
courses. 
Eligibility: Rank of Commander and above. TOP 
SECRET Security Clearance required. 
In view of the shortage of travel funds for Fiscal 
Year 1965, only a limited number of officers can be 
authorized to attend these courses on travel and per 
diem orders chargeable against Bureau of Medicine and 
Surgery funds. Eligible and interested officers who 
cannot be„ provided with travel orders to attend at Navy 
expense may be issued Authorization Orders by their 
Commanding Officers following confirmation by this 
Bureau that space is available in each case. Requests 
should be forwarded in accordance with BUMEDINST. 
1520.8 and comply with the deadline dates indicated 
above. All requests must indicate that a security clear- 
ance of TOP SECRET has been granted to the officer 
requesting attendance, and if Bachelor Officer's Quarters 
are desired. 
— Training Branch, Professional Div., BuMed. 



20 



U.S. NAVY MEDICAL NEWS LETTER 



IMPORTANT NOTICE 



U.S. Navy Medical News Letter Renewal Request Is Required 

Existing regulations require that all Bureau and office mailing lists be checked and circularized once each year in 
order to eliminate erroneous and duplicate mailings. 

It is, therefore, requested that EACH RECIPIENT of the U. S. Navy Medical News Letter (Except U. S. Navy 
and Naval Reserve personnel on ACTIVE DUTY and U. S. Navy Ships and Stations) fill in and forward immedi- 
ately the form appearing below if continuation on the distribution list is desired. However, all recipients, Reg- 
ular and Reserve, are responsible for forwarding changes of address as they occur. 

Failure to reply to the address given below by 15 February 1965 will automatically cause your name to be 
removed from the files. If you are in an Armed Service other than Navy, please state whether Regular, Reserve, 
or Retired. 

Also, PLEASE PRINT LEGIBLY. If names and addresses cannot be deciphered, it is -impossible to maintain 
correct listings. 

— Editor 



(Detach here) 



Commanding Officer, U. S. Naval Medical School 

National Naval Medical Center (date) 

Bethesda, Md„ 20014 

(Attn: Addressograph Office) 



I wish to continue to receive the U. S. Navy Medical News Letter. 



Name 
of 

Activity Ret 

or (Print or type, last name first) (rank, service, corps) 

Civilian Status 



Address 



(number) (street) 
Qty Zone State 



(SIGNATURE) 
U.S. NAVY MEDICAL NEWS LETTER 21 



DEPARTMENT OF THE NAVY 

U. S. NAVAL MEDICAL SCHOOL 

NATIONAL NAVAL MEDICAL CENTER 

BETHESDA, MARYLAND 20014 



POSTAGE AND FEES PAID 

NAVY DEPARTMENT 



OFFICIAL BUSINESS 



PERMIT NO. ioaa 



22 



U.S. NAVY MEDICAL NEWS LETTER